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The world is experiencing a sudden surge in urban population, especially in developing Asian and African countries. Consequently, the global burden of cardio-metabolic disease (CMD) is also rising owing to gut microbiome dysbiosis due to urbanization factors such as mode of birth, breastfeeding, diet, environmental pollutants, and soil exposure. Dysbiotic gut microbiome indicated by altered Firmicutes to Bacteroides ratio and loss of beneficial short-chain fatty acids-producing bacteria such as Prevotella, and Ruminococcus may disrupt host-intestinal homeostasis by altering host immune response, gut barrier integrity, and microbial metabolism through altered T-regulatory cells/T-helper cells balance, activation of pattern recognition receptors and toll-like receptors, decreased mucus production, elevated level of trimethylamine-oxide and primary bile acids. This leads to a pro-inflammatory gut characterized by increased pro-inflammatory cytokines such as tumour necrosis factor-α, interleukin-2, Interferon-ϒ and elevated levels of metabolites or metabolic endotoxemia due to leaky gut formation. These pathophysiological characteristics are associated with an increased risk of cardio-metabolic disease. This review aims to comprehensively elucidate the effect of urbanization on gut microbiome-driven cardio-metabolic disease. Additionally, it discusses targeting the gut microbiome and its associated pathways via strategies such as diet and lifestyle modulation, probiotics, prebiotics intake, etc., for the prevention and treatment of disease which can potentially be integrated into clinical and professional healthcare settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Background/aims: Current childhood fat mass (FM) assessment techniques are not suitable for clinical and population-level adiposity assessment. A prediction model, which accurately estimates childhood FM using predictor variables of weight, height, age, sex and ethnicity, requires validation in Arab populations. We evaluate the model's performance in Kuwaiti, Lebanese and Moroccan children/adolescents., Methods: Data from three cross-sectional studies on 471 individuals, aged 6-15 years, were obtained with complete information on predictors and the outcome of log transformed fat-free mass assessed by reference standard deuterium dilution (lnFFM). Country-specific predictive performance statistics of R 2 , calibration slope and calibration-in-the-large (measures the calibration/agreement between observed and predicted lnFFM with ideal values of 1 and 0, respectively) and root mean square error (RMSE) were quantified and pooled across countries via random-effects meta-analysis. FM estimates from bioimpedance were also available for Lebanese children and were compared to the reference standard., Results: The model showed strong predictive ability in all populations. Pooled R 2 calibration slope and calibration-in-the-large values on the original lnFFM scale were 87.73% (95% CI: 77.20, 98.26%), 0.95 (95% CI: 0.83, 1.08) and -0.03 (95% CI: -0.16, 0.11), respectively. Model intercepts were recalibrated in each country to improve accuracy; updated country-specific equations are provided. After recalibration, RMSEs on the FM scale were 1.3, 1.6 and 2.8 kg in Kuwait, Lebanon and Morocco, respectively. The RMSE from the model was lower than bioimpedance (2.4 kg) amongst Lebanese children., Interpretation: The model explained a large proportion of the variance in FM, produced well-calibrated predictions and relatively low RMSEs in Arab settings. It predicted FM more accurately than bioimpedance, indicating its potential for implementation in clinical- and population-level settings, particularly in low- and middle-income countries., (© 2025 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

People with type 2 diabetes (T2D) have a 2-3-time higher risk of developing sarcopenia, a musculoskeletal disease marked by a progressive loss of skeletal muscle mass and strength, compared to people without T2D. This narrative review examines the effectiveness of lifestyle interventions in enhancing muscle mass and strength in people with T2D, emphasizing their growing importance with advancements in obesity treatments. PubMed and Google Scholar were utilized to identify the most relevant published studies based on the authors' knowledge. The maintenance of skeletal muscle strength and mass in people with T2D is becoming more prominent due to the advent of weight loss therapies such as low-energy diets, bariatric surgery and pharmacotherapies. Although the weight loss is to be commended, a large proportion (20-50%) of the weight loss comes from lean mass, indicative of a loss in muscle mass. There are currently no pharmacotherapies to increase, or mitigate the loss of, lean mass, with lifestyle strategies prominent in this arena. Resistance exercise is the most effective method to increase muscle mass and strength in people with T2D, but there is some evidence of an anabolic resistance. Aerobic exercise and increased dietary protein intake may result in small increases in muscle mass and strength, with no evidence of an anabolic resistance to these stimuli. Exercise and protein supplementation can increase, or aid in the retention of, muscle strength and mass in individuals with T2D, but further research is needed to explore their benefits in patients undergoing concomitant pharmaceutical and surgical treatments., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Type 1 diabetes is burdensome, requiring complex daily management and making people more prone to emotional distress. To better detect diabetes-related distress (DD) and identify at-risk patients, we aimed to provide an in-depth characterization of DD in people with type 1 diabetes., Research Design and Methods: We included adults with type 1 diabetes from the Suivi en France des personnes avec un Diabète de Type 1 cohort who filled in the Problem Areas in Diabetes questionnaire (PAID ≥40 indicates high DD). Age and sex-adjusted multivariable logistic regression models analyzed individual characteristics, clinical indicators, diabetes-related complications and psychological factors. We further analyzed DD according to six data-driven subdimensions: emotional distress, fear of complications, social distress, eating distress, management distress, and diabetes burnout., Results: In total, 1220 participants (50.6% female, age 42 years (SD 13.9), diabetes duration 24.7 years (13.6)) had a total mean PAID score of 39.6 (21.7) and 592 (48.5%) reported high DD. Leading subdimensions of DD included fear of complications (50.1 (24.4)) and diabetes burnout (45.9 (24.5)). Females, younger age, social vulnerability, smoking, and the presence of retinopathy were positively associated with high DD (p<0.05). We observed similar DD levels across HbA1c levels and treatment modalities, including automated insulin delivery and continuous glucose monitoring use. Several psychological factors, such as anxiety/depression, poor sleep quality, and treatment burden, were strongly associated with DD (p<0.001)., Conclusions: We provide a holistic clinical phenotyping approach that enables the identification of determinants and prevalence of DD, overall and according to key DD subdimensions, in a large and diverse population. Our results underscore the importance of developing DD-targeted prevention and intervention strategies focused specifically on high-risk groups and the most impactful distress subdimensions to reduce the impact of type 1 diabetes burden., Trial Registration Number: NCT04657783., Competing Interests: Competing interests: PV has received a grant from IPSEN for fundamental scientific work and personal honoraria for lectures and/or meeting attendance from Lilly, Sanofi and Urgo, outside the field of this article. SH reports receiving grants from Asdia, Asten, AstraZeneca, Homeperf, ISIS Diabete, LVL, Nestle Home Care, Pierre Fabre, and VitalAire; consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Sanofi, Servier, and Valbiotis; speaking fees from Abbott, AstraZeneca, Boehringer Ingelheim, Bayer, Dino Santé, Eli Lilly, Novartis, Novo Nordisk, Pierre Fabre, Sanofi, Servier, and Valbiotis; and meeting invitations from AstraZeneca, Abbott, Dino Santé, Eli Lilly, and Novo Nordisk. LP reports receiving consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Sanofi and Servier; speaking fees from AstraZeneca, Boehringer Ingelheim, Bayer, Eli Lilly, Novo Nordisk, and Sanofi; and meeting invitations from Eli Lilly, Sanofi and Novo Nordisk. SL has received speaker honoraria from Abbott, Novo Nordisk, Sanofi, Eli Lilly and Company, and Insulet, and has served on advisory board panels for Diabeloop and Medtronic. PYB has received speaker honoraria from Abbott, Eli Lilly, Novo Nordisk and Sanofi; is the chief medical officer for Diabeloop; and served on advisory board panels for Abbott, Dexcom, Insulet, LifeScan, Eli Lilly, Novo Nordisk and Sanofi. HH has performed clinical trials for and/or has provided advisory/speaking services for and/or has received research grants from Abbott, Air Liquide Healthcare, AstraZeneca, Insulet Isis, LifeScan, Lilly, Medtronic, MSD, Novo Nordisk, Sanofi and Vitalaire. J-PR is an advisory panel member for Sanofi, MSD, Eli Lilly, Novo Nordisk, AstraZeneca, Abbott, Dexcom, Alphadiab, Air Liquide Healthcare and Medtronic and has received research funding from and provided research support to Abbott, Air Liquide Healthcare, Sanofi and Novo Nordisk. GF has provided advisory/speaking services for and/or has received research grants and/or speaker honoraria from MSD, MSDAvenir, Eli Lilly, Roche Diabetes Care, AstraZeneca, Danone Research, Diabeloop, Bristol Myers Squibb, L’Oréal R&D, AbbVie Pharmaceutical, Pfizer, Vitalaire and Akuity Care., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Mitochondria absorb short wavelengths around 420 nm. This is associated with reduced ATP and restricted mobility. The 420-450 nm range is a significant element of LED lighting and computer monitors. Here we expose freely moving mice to 420-450 nm lighting and show rapidly weight gain within a week. This may be due to reduced mitochondrial demand for circulating carbohydrates. Both groups displayed marked shifts in serum cytokines. Open field mobility was examined. The distance travelled was similar between both experimental groups and their controls. However, both experimental groups showed avoidance of central regions consistent with anxiety-like behaviours. This was significant in the 420 nm group whose wavelength exposure is closer to peak mitochondrial absorbance. These data demonstrate the potential hazards of exposure to specific short wavelengths in the visual range now common in the built environment. Data are consistent with a wider literature on systemic problems arising from exposure to short wavelength light., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Short interpregnancy/birth interval (SIBI) may be associated with greater risks of adverse pregnancy outcomes. This study aimed to synthesise the literature on the association between SIBI and adverse maternal outcomes in Asia-Pacific., Methods: Five databases were searched for studies published between 2000 and 2023. Studies were eligible if they reported an association between SIBI and adverse maternal outcomes (e.g., anaemia). Studies that met the WHO's definition of SIBI were included in the meta-analysis. The key findings were then summarised through qualitative synthesis and meta-analyses., Results: 26 articles that examined the association between SIBI and adverse maternal outcomes and were included in the narrative synthesis. Eight studies examined anaemia, two examined antenatal or postnatal depression, three assessed gestational diabetes mellitus, and four studies examined preeclampsia. A significant association between SIBI and anaemia was reported, indicating an 181 % increase in anaemia with a SIBI (OR of 2.81;95 % CI: 1.30-4.31) compared to an optimal birth interval. There was a significant association between SIBI and gestational diabetes mellitus (OR of 0.68; 95 % CI: 0.65-0.71), antenatal or postnatal depression (OR of 2.36; 95 % CI: 1.76, 3.01) but no significant associations were found for preeclampsia (OR of 0.74; 95 % CI: 0.48-1.01)., Conclusion: Our review highlights that SIBI places women at an increased risk of adverse maternal outcomes compared to optimal birth interval. This indicates the importance of addressing short birth interval through effective contraception as a key maternal health intervention to reduce adverse maternal outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: The assessment of scientific articles is essential for making informed decisions regarding promotion, tenure, and funding, as well as for identifying influential research within a specific field. Traditional metrics like citation count have been the standard for evaluating the reach and influence of publications, but they have limitations. A new web-based metric-the Altmetric Attention Score (AAS)-offers a dynamic analysis of online engagement through social media platforms, including X (Formerly Twitter), Facebook, and YouTube. This study primarily examines the role of X activity in shaping AAS and explores its correlation with traditional citation counts in sleep medicine journals., Methods: The study included articles from the top 10 sleep journals ranked by impact factor, focusing on articles published in 2020 and 2021. Data on citation counts were extracted from Journal Citation Reports (JCR), while AAS data were retrieved from the Altmetrics website. The analysis primarily focused on X activity as a proxy for online engagement. Pearson's and Spearman's correlations were used to evaluate the relationship between AAS, citation counts, and X activity. Statistical analysis was conducted using R software., Results: A total of 3,944 articles were analyzed. The average AAS was 20, with a median of 2. A weak but statistically significant positive correlation (r = 0.22, P < 0.001) was observed between AAS and citation counts. X activity showed a strong correlation with AAS (r = 0.65, P < 0.001), but only a weak correlation with citation counts (r = 0.16, P < 0.001)., Conclusion: This study highlights the strong relationship between X activity and AAS, emphasizing X's role in influencing Altmetric scores. However, the weaker correlation between AAS and citation counts implies that while AAS may measure immediate online attention, it is not always a reliable predictor of long-term academic impact., Competing Interests: Declarations. Research involving human participants and/or animals: This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent: Not applicable, as no human participants were involved. Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (© 2025. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Being "between Scylla and Charybdis" is an idiom derived from Greek mythology to mean "between a rock and a hard place" and clinicians managing amyloid light-chain (AL) amyloidosis often find themselves in this predicament. AL amyloidosis is caused by monoclonal light chains, most commonly produced by CD-38 positive plasma cells in target organs. The disease usually involves significant cardiac and/or renal involvement, but the systemic nature of the disease often leads to variable and non-specific manifestations that can critically delay early diagnosis and treatment. Here, we present a case series reflecting primarily the cardiologist and hematologist perspective to uniquely illustrate key learnings that we believe have the potential to improve diagnosis timelines, treatment initiation, and ultimately improve outcomes for this severe disease. Through our case series, we illustrate that to achieve an accurate diagnosis, a high degree of clinical suspicion is needed, and we stress the important requirement of substantial multi-disciplinary collaboration. Our experience strongly indicates that AL amyloidosis patients presenting with cardiac symptoms need to be identified and treated rapidly, prior to the development of irreversible cardiotoxicity. In addition, patients without significant cardiac involvement may benefit from rapid initial treatment with daratumumab along with cyclophosphamide-bortezomib-dexamethasone, which can render patients eligible for autologous stem cell transplant (ASCT) or in some instances means they can forgo ASCT completely. Increased awareness of the disease is needed among general cardiologists and hematologists, and specialized centers with the relevant expertise should be willing to accept patients for fast-track evaluation as part of their standard procedures, due to the unique contribution they can offer in the clinical management of this life-threatening disease., Competing Interests: H.S. declares no competing interests. F.K. has received honoraria for advisory boards for Roche, Janssen Pharmaceuticals, Sanofi and Takeda. A.A. has received honoraria for presentations, advisory boards and travel grants from Janssen Pharmaceuticals. A.H. declares no competing interests. Jawahir Alamari declares no competing interests. S.A. declares no competing interests. D.M. has received institution grants, honoraria for presentations and advisory boards and travel support from Pfizer Inc, Novartis, AstraZeneca, and Abbott Laboratories. G.P. has received honoraria from Alexion, Janssen, Pfizer, and Prothena., (© The Author(s), 2025.)

Background: Achieving an in-range glycated haemoglobin (HbA1c) is essential for managing diabetes mellitus (DM). However, this parameter provides an estimate of long-term blood glucose control rather than daily glycaemic variations. Glycaemic variability can be more predictive than HbA1c in terms of identifying those at risk for diabetes complications, including risk of severe respiratory virus infections and is usually measured via a continuous glucose monitor (CGM). For individuals for whom a CGM is not available, serum 1,5 anhydroglucitol (1,5-AG) level has shown potential as an alternative method for monitoring glycaemic variability. Despite this, at present 1,5-AG is not routinely used in the clinical assessment of DM. Here, we aim to determine whether assessing 1,5-AG, in addition to HbA1c, is of any potential clinical utility to the management of DM for patients., Methods: Using machine learning and data derived from 78 patients with type I DM (for whom CGM data is available) we show that the combination of 1,5-AG and HbA1c improves the prediction of a patient's glycemia risk index (GRI) compared to HbA1c alone., Results: The GRI is an essential tool in the management of DM as it reflects both clinical priorities and patient centred outcomes. The inclusion of 1,5-AG in this prediction was particularly important for individuals who had very high or very low GRI. Furthermore, in the context of glycaemic variability and susceptibility to severe respiratory virus infections, we show that reduced 1,5-AG in the plasma is associated with reduced ex vivo CD4 + T cell cytokine responses to influenza virus in individuals with a matched HbA1c., Conclusions: Taken together, these data argue for an increased monitoring of 1,5-AG in the clinic for individuals without a CGM to provide additional insights for diabetes management., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by Mater Research Ethics Committee (HREC/MML/55151 V2) and UQ Ethics Committee (2019/HE002522). All methods were performed in accordance with institutional guidelines and regulations. Written consent was obtained from all study participants. The study was also approved by the ethics committee (CPP Est I, Dijon, France), and each participant gave written informed consent prior to participation. Consent for publication: All authors have approved the final manuscript and consent to publication. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Malate is an important dicarboxylic acid produced from fumarate in the tricarboxylic acid cycle. Deficiencies of fumarate hydrolase (FH) and malate dehydrogenase (MDH), responsible for malate formation and metabolism, respectively, are known to cause recessive forms of neurodevelopmental disorders (NDDs). The malic enzyme isoforms, malic enzyme 1 (ME1) and 2 (ME2), are required for the conversion of malate to pyruvate. To date, there have been no reports linking deficiency of either malic enzyme isoforms to any Mendelian disease in humans. We report a patient presenting with NDD, subtle dysmorphic features, resolved dilated cardiomyopathy, and mild blood lactate elevation. Whole exome sequencing (WES) revealed a homozygous frameshift variant (c.1379&#95;1380delTT, p.Phe460fs*22) in the malic enzyme 2 (ME2) gene resulting in truncated and unstable ME2 protein in vitro. Subsequent deletion of the yeast ortholog of human ME2 (hME2) resulted in growth arrest, which was rescued by overexpression of hME2, strongly supporting an important role of ME2 in mitochondrial function. Our results also support the pathogenicity and candidacy of the ME2 gene and variant in association with NDD. To our knowledge, this is the first report of a Mendelian human disease resulting from a biallelic variant in the ME encoding gene. Future studies are warranted to confirm ME2-associated recessive NDD., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Few studies have examined where clients receive methadone treatment for opioid use disorder relative to their residences. Commuting time affects access to care, and anecdotal evidence suggests clients often bypass closer methadone providers. This study quantifies (a) bypass patterns in Los Angeles County, (b) gender, age, and ethnoracial differences in bypassing, and (c) links between bypassing and facility attributes., Methods: Using retrospective multiyear analysis, we matched opioid treatment episodes with commuting times between clients' ZIP codes and treatment facilities. From 16 972 outpatient episodes (2010-2017), data were paired with Google Maps commuting estimates. The study covered 32 methadone facilities and 8627 unique clients. We determined the difference in driving time (a proxy for commuting time) from the nearest (bypassed) provider to the provider where the client was treated, deriving bypass and extended commute rates. We compared the rates of a scaled bypassing variable across racial, ethnic, and gender groups. We examined rates by grouping and by facility characteristics of the closest provider., Results: Bypassing occurred in 48.9% of episodes; 21.0% involved extra commute time of 5+ minutes beyond the closest facility. Bypass rates varied significantly across racial, ethnic, and gender groups. Black or African American clients showed higher bypass rates than non-Latino white clients. Latino female clients had lower rates and shorter commutes than Latino male clients ( P  < .01). Larger methadone facilities experienced fewer bypassing and Black clients were found to typically bypass in favor of providers with longer wait times than other groups in the study., Implications: This is the first study investigating client and facility characteristics relating to methadone treatment bypassing in a major U.S. care system. The results highlight significant bypass rates affecting efficient access. Findings have implications for opioid treatment system design, particularly to improve access to quality care for underserved communities., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2025.)

Background and Objectives : Heart failure (HF) often leads to worsening renal function (WRF), negatively impacting patient outcomes. This study aims to examine the incidence of WRF in HF patients, identify its risk factors, and assess its effect on readmissions. Materials and Methods : This retrospective analysis included 297 HF patients admitted to Harlem Hospital Center between January 2019 and December 2021. WRF incidence and its association with risk factors, hospital stays, and readmissions were analyzed. Data on age, type 2 diabetes, chronic kidney disease, high-dose furosemide use, and biomarkers (ProBNP, troponin T, creatinine) were collected. A risk-scoring system was developed to identify patients at higher risk for WRF. Results : WRF occurred in 27% of patients, with a significant correlation to longer hospital stays and lower cardiology follow-up adherence. Risk factors for WRF included older age, type 2 diabetes, chronic kidney disease, high-dose furosemide, and elevated ProBNP, troponin T, and creatinine levels. The risk scoring system revealed that patients scoring 6 or higher were four times more likely to develop WRF. Interestingly, WRF did not increase 30-day readmission rates. Conclusions : This study highlights the high incidence of WRF among HF patients, its impact on hospital stays and follow-up adherence, and the utility of a risk-scoring system to identify vulnerable patients. The findings offer valuable insights into improving care in minority-serving hospitals and provide a foundation for future research on WRF in HF patients.

Purpose: Obesity is a major risk factor in Obstructive sleep apnea (OSA), which is a prevalent disease that leads to significant morbidity. Multi-level Sleep Surgery (MLS) is a method of treatment for patients who cannot tolerate continuous positive airway pressure. Obesity has previously been identified as a risk factor that may decrease the success rate of MLS. The purpose of our study is to assess the success rates of MLS in obese patients., Methods: A retrospective cohort study in 109 adults that underwent MLS in our institution. All the participants completed pre-operative and post-operative level 1 polysomnography. They were divided into four groups as per their body mass index (BMI): Normal (BMI < 25), overweight (25-30), obese (30-35), morbid obese (> 35) and the variables were compared. We measured the surgical success as defined by Sher Criteria (AHI drop > 50% from preoperative baseline and AHI < 20) and cure rates (AHI < 5)., Results: The average BMI was 30.9 pre-op and 30.4 post-op. The mean AHI was 29.8 pre-op and decreased to 10.1 (p < 0.001) and the Epworth Sleepiness Scale from 12.9 to 4.8 (p < 0.001). There were 13, 31, 43, and 22 patients in normal, overweight, obese and morbidly obese groups, respectively. The surgical success rate as defined by Sher's criteria was 84%, 84%, 72%, and 77% in the respective groups, with no statistical difference (p = 0.662). Moreover, the cure rate was 77%, 45%, 44%, and 45%, with no statistical difference (p = 0.192). The AHI reduction was 9.93, 19.73, 21.1 and 22.8 in the respective groups. A linear regression analysis revealed no significant difference in assessing the surgical success and cure rates as BMI increases., Conclusion: Data regarding MLS success rates on obese patients is scarce. The current study demonstrates that MLS can offer positive outcomes for this population. However, further studies are warranted to investigate this relationship., Competing Interests: Declarations. Ethical approval: Study specific ethical approval was granted by the ethics committee at the Ministry of Health in Kuwait and conformed to the standards and the latest revision of the declaration of Helsinki. Informed consent: Informed consent was obtained from all individual participants included in the study. Prior presentation: The research was presented as a poster presentation in the “2023 International Sleep Surgery Society Meeting” in Nashville, Tennessee on 29th September 2023. Conflict of interest: The authors have no competing interests to declare that are relevant to the content of this article., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Anxiety disorders are the second most common mental health disorders in terms of disability-adjusted life years and years of life lost across all age groups. A bidirectional relationship between anxiety disorders and diabetes mellitus has been documented. This study aimed to determine the prevalence of anxiety and its associated factors among patients with diabetes receiving care at public primary care clinics in Kuwait during the first quarter of 2024., Methodology: A cross-sectional study was conducted in the first quarter of 2024 at three primary healthcare centres within the Capital Governate in Kuwait City. Adults with diabetes mellitus for longer than six months duration were requested to participate by the health promoters and the Generalised Anxiety Disorder questionnaire was shared via a mobile link/QR scan. Data were collected through self-or interviewer-administered surveys, cleaned and coded in Microsoft Excel, and analysed using STATA version 18. Descriptive analysis was initially conducted followed by bivariate and multivariate analysis with a p < 0.05 and a 95% confidence interval used to determine the association between demographic and clinical factors and GAD., Results: A total of 554 patients participated, yielding an 80% response rate. Anxiety symptoms were observed in 48% of respondents, though only 4% (n = 25) had a GAD score > 10. Among participants with moderate-to-severe anxiety (n = 21), 52% were aged 50-59 years, 90% were non-native Kuwaiti citizens, and 62% had an HbA1C measurement > 7 mmol/L. Multivariate analysis indicated that non-native Kuwait citizens were significantly more likely to have moderate-to-severe anxiety (AOR: 6.99, 95% CI: 1.42-34.43) compared to Kuwaiti nationals. Conversely, participants attending clinic visits every two months were less likely (AOR: 0.30, 95% CI: 0.00-0.50) to report moderate-to-severe anxiety symptoms than those attending monthly., Conclusion: While nearly half of patients with diabetes displayed anxiety symptoms, only a small proportion (4%) experienced moderate-to-severe anxiety. Non-native Kuwaiti residents were significantly more likely to have GAD scores > 10. Integrating anxiety screening into diabetes care may improve outcomes for this high-risk group., Competing Interests: Declarations. Ethics approval and consent to participate: All tenets of the Declaration of Helsinki were complied with. and the study obtained ethical clearance from the Ministry of Health (2023/2347) in Kuwait and the ethics committee of the Dasman Diabetes Institute in Kuwait City (P202313). All participants signed an informed consent declaration digitally. Consent for publication: Participants provided permission for the use of anonymised data for publication. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Biologic therapies treat patients with moderate to severe inflammatory bowel disease (IBD). This study aims to investigate the demographics of biologic therapy use and its association with patient characteristics, a topic that has not yet been thoroughly assessed in our region., Methods: Electronic health record data from June 1, 2021, to May 31, 2023, were collected at a tertiary care IBD center in Kuwait. The primary outcome of this single-center cross-sectional study was to assess the demographics of use of various biologic therapies among patients with IBD. The secondary outcome was to assess whether the type of biologic therapy differed based on gender, age, and IBD type., Results: Among the 513 patients using biologic therapy in this study, there were 210 (40.9%) on adalimumab (ADL), 154 (30.0%) on infliximab (IFX), 112 (21.9%) on ustekinumab (UST), and 33 (6.4%) on vedolizumab (VDZ). Patients taking VDZ were more likely to have ulcerative colitis (UC) ( p  < 0.001) and were more likely to be over 30 years old ( p  < 0.001). In contrast, patients on UST were less likely to be over 30 ( p  = 0.011) and more likely to have Crohn's disease (CD) ( p  < 0.001). In addition, patients on ADL were more likely to have Crohn's disease ( p  = 0.003), as were patients on IFX ( p  < 0.001)., Conclusion: Patients taking VDZ were more likely to have UC and be over 30 years of age, while those on UST were more likely to be under 30 years of age and to have CD. Additionally, patients on ADL and IFX were more likely to have CD. This study highlighted the need for further research evaluating physicians' preferences and the effectiveness of different biological therapies in patients with IBD., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe complication arising from SARS-CoV-2 infection, with indications that rare inborn errors of immunity may play a role in its pathogenesis. Recent studies suggest that genetic predispositions, particularly monogenic forms, could significantly influence the immune responses to SARS-CoV-2 in MIS-C., Methods: We analysed 24 children under 12 years old, all of whom met the criteria provided by the World Health Organization, 2020 for MIS-C diagnosis, from the Paediatric COVID-19 Registry in Kuwait (PCR-Q8). Demographic and clinical data were collected from medical records, and exome sequencing was performed on the children and their parents to identify rare exonic variants. These variants were prioritized using two approaches: a candidate genes approach employing trio segregation analysis, and a candidate variants approach using a gene panel informed by previous studies on MIS-C-related genetic variants and datasets of differentially expressed genes in MIS-C patients., Results: The candidate genes approach identified 53 unique genes in 20 of the 24 probands, including DDX60 and TMEM154 , which were also differentially expressed between MIS-C and control groups. The candidate variants approach identified 33 rare, predicted deleterious heterozygous variants across 19 unique genes in 19 of the 24 probands, including both previously described and novel candidate variants for MIS-C. Pathway analysis of the identified genes from both approaches revealed significant involvement in immune response, viral defence, and inflammatory pathways., Conclusion: This study underscores the monogenic susceptibility to MIS-C, enhancing the evidence base through comprehensive genetic analysis. The findings highlight the critical role of genetic predispositions in MIS-C and suggest that further functional genomics work is necessary to explore the mechanistic contributions of these genes, facilitating the development of targeted diagnostic strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Dashti, AlKandari, Malik, Nizam, John, Jacob, Channanath, Othman, Al-Sayed, Al-Hindi, Al-Mutari, Thanaraj and Al-Mulla.)

Introduction: Childhood adiposity markers can be standardised for height in the form of indices (marker/height p ) to make meaningful comparisons of adiposity patterns within and between individuals of differing heights. The optimal value of p has been shown to differ by birth year, sex, age, and ethnicity. We investigated whether height powers for childhood weight and fat mass (FM) differed by birth year, sex, or age over the period before and during the child obesity epidemic in Copenhagen., Setting/methods: Population-based cross-sectional study of 391,801 schoolchildren aged 7 years, 10 years and 13 years, born between 1930 and 1996, from the Copenhagen School Health Records Register. Sex- and age-specific estimates of the height powers for weight and FM were obtained using log-log regression, stratified by a decade of birth., Results: For weight, amongst children born 1930-39, optimal height powers at 7 years were 2.20 (95% CI: 2.19-2.22) for boys and 2.28 (95% CI: 2.26-2.30) for girls. These increased with birth year to 2.82 (95% CI: 2.76-2.87) and 2.92 (95% CI: 2.87-2.97) for boys and girls born in 1990-96, respectively. For FM, amongst those born 1930-39, powers at 7 years were 2.46 (95% CI: 2.42-2.51) and 2.58 (95% CI: 2.53-2.63) for boys and girls, respectively, and increased with birth year reaching 3.89 (95% CI: 3.75-4.02) and 3.93 (95% CI: 3.80-4.06) for boys and girls born 1990-96, respectively. Powers within birth cohort groups for weight and FM were higher at 10 years than at 7 years, though similar increases across groups were observed at both ages. At 13 years, height powers for weight and FM initially increased with the birth year before declining from the 1970s/80s., Conclusion: Due to increases in the standard deviation of weight and FM during the obesity epidemic, optimal height powers needed to standardise childhood weight and FM varied by birth year, sex, and age. Adiposity indices using a uniform height power mean different things for different birth cohort groups, sexes, and ages thus should be interpreted with caution. Alternative methods to account for height in epidemiological analyses are needed., Competing Interests: Competing interests: JLB has received consulting fees from Novo Nordisk A/S. Ethics approval: The Danish Data Protection Agency approved this study (permission no. P-2019-832). According to Danish law, purely register-based studies in which individuals are not contacted are exempt from approval by an ethics committee., (© 2024. The Author(s).)